OBJECTIVE: The goal was to evaluate and describe the use of a frameles
s, computed tomography-guided, stereotactic technique in complex proce
dures involving the craniocervical junction. METHODS: Eleven procedure
s, including transoral odontoid resection, posterior atlantoaxial fusi
on with transarticular C1-C2 screw fixation, and spinal tumor resectio
n, were performed in the preceding 26 months. In each case, frameless
stereotaxy was used to plan the incision, to define resection margins,
and to determine the appropriate orientation for instrumentation. RES
ULTS: There were no intraoperative complications noted. Each patient u
nderwent adequate resection of the pathological lesion and satisfactor
y placement of instrumentation. The stereotactic system provided detai
led anatomic visualization, which increased the confidence of the surg
eon during the procedure. The system limited the need for extensive su
rgical exposure, reduced fluoroscopy time, and decreased the risk of n
eurovascular injury. CONCLUSION: Frameless stereotaxy provided the sur
geon with intraoperative information regarding the extent of bone and
soft tissue resection. It provided a multidimensional view of anatomic
relationships in the operative field, which significantly increased s
urgical accuracy and safety.